Provider Demographics
NPI:1770697716
Name:SARDINA, DEBBIE D (MA, LCPC, LMHC)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:D
Last Name:SARDINA
Suffix:
Gender:F
Credentials:MA, LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1170
Mailing Address - Country:US
Mailing Address - Phone:312-406-3776
Mailing Address - Fax:
Practice Address - Street 1:57 MICHIGAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5392
Practice Address - Country:US
Practice Address - Phone:312-406-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional